2008 Camp Registration   Camps Select Boy's Junior (born in 1991 & 1992) Girl's Junior (born in 1991 & 1992) Boy's Youth (born in 1993 & 1994) Girl's Youth (born in 1993 & 1994) Boy's & Girl's Development (born in 1995, 1996, and later)   First Name*: Middle Initial: Last Name*:   Mailing Address*:   City*: State*: Zip*:   Player Email:   Home Phone*: Player Cell Phone:   Date of Birth* (MM/DD/YY): Gender*: Select M F Height*:     USAWP Number*:   Expiration:   100 breast time*:    100 free time*:      50 free time*:     Position Select Goalie 2m Set 2m Defender Attacker   Strong Hand*:     Parent1 Name*: Parent1 Email*:   Parent1 Phone*: Parent1 Cell Phone*:   Parent2 Name: Parent2 Email:   Parent2 Phone: Parent2 Cell Phone:   Emergency Contact*: Emergency Phone*:   Health Plan*: Number:   Doctor*: Dr Phone*:   Medical Issues:   Previous Injuries:   RELEASE I hereby waive all claim or claims against USA Water Polo Inc., Pacific Water Polo Inc., the Pacific Zone Executive Board, its agents and employees for personal injury to myself or my children while participating in the above Pacific Zone Program(s). I further agree to indemnify and hold harmless USA Water Polo, Inc., Pacific Water Polo Inc., the Pacific Zone Executive Board, its agents and employees from any claim or claims for personal injury or property damage against said entity arising from any activity by myself or my child(ren) which causes such injury or damage. I hereby authorize qualified physicians to render medical treatment or care that they may deem necessary for my child(ren) in case of illness or accident during such program(s). Name of person completing this form: By clicking here I represent that my click is my signature for this liabililty release.